Credentialing Specialist

3 weeks ago

Pasig, Philippines Remote VA Full time

We are seeking a detail-oriented and experienced Credentialing Specialist with a strong background in ABA therapy services to manage the credentialing and re-credentialing processes for our clinicians and facilities. The ideal candidate is well-versed in payer enrollment requirements, particularly for ABA providers, and can navigate commercial and Medicaid insurance portals with ease. This role ensures that all clinicians are properly credentialed and compliant, allowing uninterrupted service delivery and reimbursement.

Key Responsibilities:
  • Complete and maintain credentialing and re-credentialing applications for BCBAs, RBTs, and other ABA clinicians
  • Submit applications to commercial and Medicaid payers, including CAQH, NPI, PECOS, and individual payer portals
  • Track credentialing statuses, follow up on delays, and maintain regular communication with insurance companies
  • Maintain up-to-date records of licensure, certifications, background checks, liability insurance, and other compliance documentation
  • Coordinate start dates with HR and scheduling teams to ensure clinicians are active before seeing clients
  • Ensure accuracy and timely submission of demographic updates, reassignment of benefits, and provider termination notices
  • Monitor credentialing expiration dates and initiate renewals in advance
  • Assist billing team with credentialing-related claim denials and payer issues
  • Stay updated with payer policy changes and credentialing guidelines, especially those impacting ABA services
  • Credentialing experience, preferably in ABA or behavioral health
  • Strong knowledge of credentialing processes and insurance requirements (Medicaid, private payers, CAQH, etc.)
  • Familiarity with BACB and state licensing requirements for ABA professionals
  • Excellent organizational and time management skills
  • Strong written and verbal communication skills
  • Proficiency with EMR systems like CentralReach, Rethink, or Catalyst
  • Ability to manage sensitive information with a high level of confidentiality and accuracy
  • Knowledge of ABA-specific billing and compliance processes

Purely work-from-home

Night Shift (EST)

Weekly pay

#J-18808-Ljbffr

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